Healthcare Credentialing Specialist

Job Description

Job Description

LONGTERM CONTRACT WITH POTENTIAL TO BE HIRED DIRECTLY BY THE CLIENT. If you feel you are a perfect match for this position, please connect with me directly on LinkedIn, and message me! 2 days a week in office/Detroit. Long term growth potential, great foot in the door. Tom Cassidy/OPTECH

This role is responsible for managing the credentialing and recredentialing process for healthcare providers and organizations to ensure compliance with state, federal, and NCQA accreditation standards .
The position includes reviewing applications, verifying credentials through primary sources, maintaining accurate records, and communicating status updates to internal teams and providers. The role also supports audits, resolves inquiries, and may participate in committee meetings and special projects.
It is a hybrid position requiring 2 days onsite per week , with the candidate residing in the local metropolitan area.

 

Top Required, Must-Have Skills:

1. Credentialing processing experience (provider/practitioner/facility)

2. Knowledge of state & federal regulations (NCQA, CMS, DIFS, MDHHS)

3. Experience with CAQH

4. Strong organizational skills & attention to detail

5. Ability to manage multiple cases and deadlines simultaneously

6. Strong verbal and written communication skills

7. Ability to work independently and in a team environment

8. Proficiency in Microsoft Office (Word, Excel, Access, PowerPoint)

Preferred Skills

1. Experience in provider enrollment, medical practice, hospital business office, or contracting

2. Experience participating in credentialing committees or audit processes

3. Exposure to process improvement, job aids, or special projects

 

Years of Experience Required

• Required:
• • 2 to 5 years of relevant experience in:
  • • Provider enrollment
    • Credentialing
    • Medical practice or hospital business office
    • Healthcare contracting or related field

 

Education Requirements

• Preferred:
• • Associate degree
• (Relevant professional experience can support qualifications even if degree is not strictly required)

Client notes are below:

Job Description:

Onsite – Tower Building 600 Lafayette Detroit MI
The resource will be required to work onsite two days per week and may work remotely for the remaining three days.
Resource must live in the metropolitan area.

Summary
Process practitioner and organizational provider applications for credentialing based on State and Federal
regulations and NCQA accreditation standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Responsible for the processing of practitioner and organization/facility provider applications for
credentialing and recredentialing; requesting primary source documentation, processing documentation
requirements, verifying information received, updating information in the system of record, evaluating over
all case categorization and reporting findings to the Medical Director and Enterprise Credentialing
Committee.
2. Resolve inquiries related to credentialing file disposition.
3. Provide credentialing status information for group administrators, physicians and their staff, Provider
Services, Customer Service and Network Development Inquiries.
4. May bedesignated by the leader to attend Credentials Committee meetings and conduct internal meetings and
participate in auditing processes.
5. Assist with special projects and job aids as needed.

EDUCATION AND EXPERIENCE
1. Associate degree preferred.
2. Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital
business office role and/or credentialing related field required.
3. Knowledgeof related state/federal regulations, NCQA, DIFS,MDHHS and CMS standards for credentialing
required.
4. Knowledgeof CAQH required.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES
1. Excellent organizational skills with attention to detail required.
2. Excellent verbal and written communication skills required.
3. Ability to handle and prioritize multiple case files and timelines required.
4. Ability to work effectively independently or in a team environment required.
5. Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required. \nCompany Description

Why work at G-Tech?
G-Tech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at G-Tech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today!

G-Tech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.




By submitting your application, you acknowledge that recruiting technologies, including AI-assisted tools, may be used to support candidate evaluation, sourcing, matching, and communications.

Company Description

Why work at G-Tech?\r\nG-Tech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at G-Tech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today!\r\n\r\nG-Tech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.\r\n \r\nBy submitting your application, you acknowledge that recruiting technologies, including AI-assisted tools, may be used to support candidate evaluation, sourcing, matching, and communications.